| NPI | 1922480193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NM AA2015-002) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000193) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2025-01-09 |